Sunday, November 22, 2009

Welcome to the November Carnival of Breastfeeding: Breastfeeding experiences in the hospital

This month we're bringing you posts on the topic of breastfeeding while either you or your child are in the hospital. Be sure to check out the links at the end for the other participants' excellent posts!

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I've had two breastfeeding experiences in the hospital: one when Mikko was born, and one when he was a year old and needed minor surgery.

The first was not a good experience. I almost feel bad harping on it, because I know the nurses didn't mean any harm. But not meaning harm and not causing harm are two different things, aren't they?

I gave birth to Mikko after 42 hours of labor. He was born in the early morning, and we closed the blinds so Sam and I could finally get a little sleep. Nurses kept coming into our room, as they are wont to do, and opening the blinds. They were very insistent that we be awake during the day, for some reason (as if newborns care what time of day it is!), and that Mikko get some sunlight (he wasn't jaundiced, and he had most recently been accustomed to a dark womb for nine months!). Every shift change, and there were several unusual ones because of various situations that called a nurse to a different wing, a new nurse would come in, wake us up, and give us breastfeeding advice.

One woke me up from a dead sleep in the dark to rattle off a list of foods that breastfeeding mothers couldn't eat, including alcohol but also peppers and anything spicy. I can't remember all the foods she listed, just that almost every one was a benign food for most breastfeeding women and breastfed babies. I stared at her groggily, wondering why on earth she would believe such a thing was universal, and why she had to wake me up to tell me so. I worried about all the other mothers she had told this to who took it to heart and decided not to breastfeed if it was so restrictive.

Every nurse also took it upon herself (we saw only women nurses during our stay) to adjust my breast and Mikko on it. They did this roughly and without warning, swooping in to "correct" my latch. I wasn't having any pain, and I had not asked for help. I would have appreciated words of advice, but surprise rough handling of a delicate body part was hard to handle. They also kept readjusting my pillows and hospital bed incline, further disturbing our rest. All of their advice was contradictory, and it made me wonder if there shouldn't be a hospital policy about the "best" way to breastfeed, just to keep the contradictions lower. One would tell me I needed to lie completely on my side. The next nurse would come in and scold me for lying on my side and point out that my breast was now too low to align with my baby's mouth. Another would come in and tell me I shouldn't be lying down at all. For my part, I was feeling overwhelmed, shy, and new to this whole mothering thing, and I didn't appreciate being criticized at every shift change. In hindsight, I think a better approach would have been to have one person, preferably a certified lactation consultant, be in charge of assisting me with breastfeeding. She could come in at intervals to check whether everything was all right. Then, when I was awake and feeling conscious, she could observe my latch and offer any advice in a more sensitive manner. I'll just put that out there in case the hospital I birthed at is reading along for suggestions!

The worst nurse was the one who held us hostage in the hospital when we were beyond ready to go home and get some rest. The nurse-midwife from the delivery had signed off on my discharge. The pediatrician had signed off on Mikko's. But this one persistent nurse felt that Mikko wasn't eating well enough, and she hinted that she would refuse to sign our discharge forms and raise a stink with the hospital...unless we let her give Mikko a bottle of formula, "just to see if he could eat." It was ludicrous, and I felt that even then, but we were so exhausted and just wanted to get home to sleep in peace (with the blinds closed!). That one bottle of formula set off a week of pumping and finger feeding nightmares. To her credit, the nurse helped us arrange an electric pump rental through the hospital! She also sent us home with a bag of syringes, feeding tubes, and formula, the latter of which we stopped using after a day.

All in all, I was highly discouraged by my breastfeeding experience in my birthing hospital. It's a so-called breastfeeding-friendly hospital, in that the nurses all intended to support breastfeeding, and the goodie bag I was sent home with was really just a swaddling blanket, breastfeeding and childcare pamphlets, and some mesh undies and industrial pads. The experience showed me that just because the hospital policies are not set to undermine breastfeeding, individual nurses (and in our case, every single nurse) can sabotage a mother's intentions to breastfeed and success at breastfeeding all the same.

When Mikko was a year old, he went in for surgery to look for a missing testicle. I was worried about the surgery for many reasons, but I'll focus on the breastfeeding ones. First of all, we were told not to breastfeed him for eight hours before surgery, which according to my research with Dr. Google (but I truly do think I'm right!), is much longer than is necessary, even for an infant undergoing general anesthesia. Breastmilk digests more quickly than other foods, though not as quickly as clear liquids. A more reasonable schedule, according to the latest guidelines from the American Society of Anesthesiologists, would have allowed Mikko to breastfeed up to four hours before surgery. Both the children's hospital and Mikko's pediatrician were inflexible on their more rigid guidelines, however, so I feared the worst for how breastfeeding would pan out during the actual surgery experience.

As it turned out, everything worked much better than I'd expected. Mikko was understandably cranky about not nursing during the night, and then being cuddled close to me as we waited but still not being allowed access to his all-favorite nummies, but the hospital did allow us to stay with him until he was initially sedated, with a liquid medicine. Then a staff member carried him off gently in his arms, and I really appreciated that detail. He wasn't wheeled off on a hard gurney, but was carried away like the baby he was.

During the surgery, I badly needed to express some milk, because my breasts were engorged after not breastfeeding for the longest period I had gone since Mikko's birth. I had brought my manual pump with me, but I needed to find a room. I found the information desk and asked the receptionist there if there was a space I could use. She jumped up in excitement. They had just created a nursing and pumping room, she told me, and she led me to a small closet-size space that had a comfortable chair, a locking door, and some pump equipment within. That was fine with me, so I was able to pump in privacy without using a restroom or worrying that I would be interrupted.

The surgery was over more quickly than we'd envisioned, and soon we were being paged down to meet Mikko as he was carried out from surgery in just the same cradled fashion as he'd been brought in. He was loopy with the anesthetic and looked red-faced and sleepy in his little hospital gown. The nurses handed him to me and led Sam and me to a smallish room with a couple big chairs. They closed the doors behind them, and Sam, after a moment's hesitation, turned off the light so that Mikko could continue waking up in his own time. The nurses left us there for maybe an hour (not insisting on turning the light back on!), and Mikko just breastfed his fill and slept off the anesthesia.

I was really impressed with the way the hospital in that instance let the breastfeeding relationship play out as it's supposed to, not interfering, not commenting in a negative manner, and providing whatever support was needed. I had been a little nervous because Mikko was over a year old and therefore into the "extended breastfeeding" territory that's so uncommon in the United States, but no one at the hospital suggested through word or look that it was unusual.

So those are my tales of two hospital experiences: one that undermined breastfeeding, and one that ultimately supported it after a bit of a rocky start.

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comments:

I wrote about about our negative experience in the hospital after Peeper's birth, but having read this, I have to add that when she had open-heart surgery at a different hospital at 4.5 months old, we had a much, much more positive experience.

My first child was born 6 weeks early, and spent her first week in the NICU. It was not a good experience. I suffered complications of my own, and so before I was able to even try to breastfeed she had been given a bottle of formula. We received contradictory advice from all the nurses, and some were very opposed to my efforts to get her to latch, saying it was 'wasting energy'. My daughter didn't breastfeed successfully at any point during her hospital stay.

My son was born at term, and it was a positive experience. He was placed immediately on my chest and allowed to latch, which he did within the first 20 minutes or so. He was born at 3pm and we went home at 8pm that night, and the two nurses we dealt with seemed satisfied. Because I had midwives visiting my home later, because it was my 2nd child, and because I volunteer as a breastfeeding counsellor, they were pretty much happy to leave me to my own devices.

Our local hospitals are pretty much all seeking 'Baby Friendly' status, and so breastfeeding support is getting better. However, having a baby in the NICU is still an experience I wouldn't wish on anyone.

i had a similar situation when oscar was born. most of the nurses were no help at all. one of them actually brought me to tears by telling me that i was starving my baby.. (and i'm thinking she's lucky that my husband wouldnt hit a lady...boy was he mad..) they finally made me supplement and i refused to use a bottle, so i was also sent home with all sorts of feeding tubes and formula.

i didnt even think about it until about a month ago, but.. we tell the ladies that come to our breastfeeding classes not to take any antihistamines because they can damage your milk supply.. well, the lady that was watching me while i was in recovery from my c-section gave me benadryl because i was getting all itchy.. she was also the first one to help me breastfeed oscar..

anyway.. major problems with milk supply after that.. (probably a combo of the benadryl, stress, and bad latch)

but oscar had to go into the hospital when he was about 7 months and be under an oxygen tent.. they were very helpful then.. set the tent up over the bed so that i could stay in with him and be able to nurse.

isn't that funny? 3 people with better breastfeeding experiences OUTSIDE of the maternity ward?

Oh my! I cannot believe how intrusive the nurses were when you had just had your brand new baby! When I was reading your post, I couldn't believe that nurse after nurse would do things that seem so ridiculous to me! I'm so glad you were able to have a better experience for your baby's surgery.

Wow! what an awful experience. I wonder if they nagged you all the time after the birth because they knew you were a new mother. Yet that is the worst thing to do to undermine someone who is so vulnerable. I'm so glad you trusted your instincts and got through it.

The only time I breastfed in a hospital was when my 1-year-old daughter had to be hospitalized for impacted feces. The nurses berated me for breastfeeding her and made all sorts of rude comments. My milk kept her poor undernourished body alive until they discovered what was wrong. (she couldn't poo because of a rectal defect and therefore didnt eat. but she did breastfeed with vigor).

Meantime, I was sharing a room with 3 other mothers with newborns. None of them breastfed and all the babies had major assimilation or vomiting issues. These babies were sooooo skinny and hungry. One was allergic to the cow's milk in the formula. I so wanted to give these babies my breast and let them have what their tummies were made to have... it broke my heart.

Were these two experiences in the same hospital?? It sounds like doctors and other staff outside the maternity ward trust parents and the value of the breast more than the folks in maternity.

I had no such trouble at any of 3 different hospitals. I had even read that milk might not come in for over 48 hours - and that baby wouldn't starve.

My milk tends to come in very quickly, so none of these were an issue. I had an LC available for my 2nd birth, but she was on vacation at my 3rd. I asked 1 random nurse to please observe my latch and make sure we were good.

With my 2nd, the LC was in the delivery room, trying to stuff my nipple into baby's mouth while the doc was trying to stitch me. I'm not sure I'd recommend that!

You should totally have called the admin of your hospital, though! Some of them actually value your feedback.

I didn't get terrible advice in the hospital, mostly it was a lack of assistance at all. I was given a nipple shield when my baby was having trouble latching and when they weren't sure if she had peed they gave the option of an ounce of formula or an ultra sound on her kidneys. I chose the formula.

Fortunately, I had taken a bf class and I felt pretty good about nursing in general, so none of that impacted our breastfeeding relationship negatively.

I can't believe, though, just how intrusive nurses are in general. Friends were wont to be angry at the hospital for discharging me 48 hrs after a c-section, but I practically begged to be discharged that soon. I got NO rest in the hospital with all the comings and goings of the staff.

It would be nice to have a button the patient could push to turn on a "do not disturb" sign outside the door. So many times I was interrupted just as I was falling asleep.

Wow, you really did have a lot of opinions fired at you! Poor you, it's hard enough not quite knowing if you're doing it right the first time around without all that interfering going on. I can't beleive they forced you to give a bottle of formula in order to go home. Disgraceful.

It's great that your second hospital experience was more positive but hopefully that now applies across the entire hospital, particularly with regard to the maternity ward...

That sounds like a pretty awful experience. Mine was awful because my son with in the NICU, on a separate floor. I had few opportunities to try to nurse him, he was sleepy and wouldn't open his mouth wide enough, and so it hurt really really bad. I asked a nurse in the NICU for advice, but she only forced my son onto my breast and made him cry. Luckily, the hospital was staffed with lactation consultants, and I only got advice from them after that. One LC in particular was assigned to me. So that was a bonus. She was like my guardian angel.

But overall, I think the hospital was breastfeeding-friendly, and bedding-in-friendly, and whatnot. I just happened to have the odds against me with having him in the NICU.

I thought I should clarify that it was in fact two different hospitals: one a regular one that's supposed to be breastfeeding friendly (and to their credit, it was homebirth friendly in that I wasn't scolded for transferring from one, and a nurse-midwife attended instead of an OB & she was respectful toward my midwives), and then the second was a children's hospital in Seattle (um, pretty clear that that is Seattle Children's Hospital -- and if you know Seattle, you might be able to guess the other one). I had much lower expectations with the children's hospital, b/c our pre-surgery appts were so clinical and, I don't know, just hospital-y. But the surgery experience itself went as well as could be expected, so I'm grateful for that. I'm also grateful for the financial aid they extended us when our self-employed insurance wouldn't pay for much of the surgery. (Yes, we're the sort of people personally hoping US health care reform goes through and is not just a big mess!)

Whozat: Isn't that interesting how it can be so different? I didn't realize Peeper had such major surgery -- eep. I'm glad she's ok!

Amber: I've heard the NICU horror stories from others, too. It's such a shame that breastfeeding and breastmilk have been routinely devalued for the infants it could help the most.

Missy: We got that same attitude, that our baby was crying because he was so hungry, and it makes you feel like such a terrible mother! I agree with the Benadryl thing, too -- I always try to avoid meds like that when I can, and drink lots of water if I can't. An oxygen tent for a 7-m-old sounds scary, too -- glad they let you stay close to Oscar!

Casey: I know!! We were so ready to go home and finally sleep.

Geek in Rome: I had the feeling from the nurses and the pediatrician in the hospital that they really didn't trust me at all, that they were treating me like a 15-year-old who'd gotten pregnant by accident, and I mean no disrespect to teen mothers by saying that, because seriously -- it was such a patronizing attitude, and I really hated to be on the end of it. I had to keep reminding myself that I was mature, educated, and capable, but it was hard when they were undermining me at every turn. The ped came in and told me not to respond to my baby's cries after a week or so, because he "has to learn." I mean, come on -- are you an MD or a (bad) parenting guru? I am sorry for your poor daughter, too -- that must have been so hard! I often want to pass on my breastfeeding, but no one usually takes me up on the offer. ;)

Jorje: You're right. I'm going to write two letters: one to each hospital. They deserve to know, and maybe it will help someone else.

Olivia: It's seriously bizarre to me that (a) sick people need rest, (b) sick people go to hospitals, and (c) hospitals grant no rest, what with the lights, the sounds, the constant entering and loud talking. What's wrong with this picture?? (I'm not saying that women who birth are sick, but they certainly need rest, and the setup in hospitals is not conducive to rest of any sort!)

Sinead: I wish I'd stood my ground on that one, but we felt captive.

Lisa: I think having a lactation consultant assigned to you would be ideal, because then you'd have only one set of advice to sort through! It's funny how you mention the bedding-in-friendly thing, b/c that was another plus of the hospital I birthed at. The nurse would say "Our policy is that the baby cannot cosleep," while she sort of winked and handed him to me in bed and got him situated next to me. So, kind of weird, but at least we did cosleep there without fuss, and Sam was able to stay with me and sleep on the day bed. I liked that. But I still much preferred getting home to our own bed!

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Riding the rails with my husband, Crackerdog Sam, and our hobo kids, Mikko Lint Picker (born June 2007), Alrik Irontrousers (born May 2011), and Karsten (born October 2014). Trying every day to parent intentionally and with grace.